| NPI | 1154803823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MHCA.MC.70062312) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2026-04-01 |